peg care protocol

ERjodiRN · Mar 13, 2009

yeah your hospital should have a policy on that, but at places i've practiced we would do scheduled 50cc flushes every 4-6hrs, and placement checks each shift. if they are getting feedings you don't want a large residual at so they don't aspirate, but i don't know an exact amount. you do want to be able to aspirate stomach contents though, for placement checks, and of course the air placement checks too. i remember being told by a patients mom not to flush too much or too fast because he could feel it and it was uncomfortable....something i hadn't really thought of until she told me. sorry, i wasn't much help!

chenoaspirit, ASN, RN · Mar 13, 2009

I dont know what our "policy" is, but if a patient is receiving bolus feedings, possibly q 4 hours, we have to check residual before administering each one. If its over 50-75 mls, we hold the tube feed until its less. If they are receiving continuous tube feeds, we check residual TID and hold for residual.

I found this on an educational website...

Common causes of How to

feeding tube obstructions prevent problems

Tubing or delivery set kinked * Examine the feeding tube and

delivery system regularly to

ensure that it's stabilized, it's

anchored properly, and it has no

kinks or twisted tubing.

Percutaneous endoscopic * Make sure the tube rotates

gastrost (PEG) tube freely. If a PEG tube is immobile,

kvembedded internally notify the physician immediately.

("buried bumper" syndrome)

Inadequate or infrequent * Institute a routine flushing

of the flushin feeding tube; protocol: Flush the tube with

formula residue adhering about 30 ml of warm water every

to tube lumen 4 hours during continuous feeding

or before and after

intermittent feedings.

Administration of inadequately * Ask the pharmacist if a liquid

crushed form is available and appropriate.

and dissolved pills * Notify the physician to discuss

any possible changes in

medication.

Administration of viscous * Flush the tube with about 30 ml

formula (those with higher of water before giving medication.

calorie content or * Give each medication separately

containing fiber) and flush with about 10 ml of

or medications, particularly water between each.

medications known to * Flush the tube with about 30 ml

cause clogging, such as of water after you've given

antacids, psyllium all medications.

(Metamucil), or sucralfate * Don't add medications directly

to the feeding bag or container

of formula.

* Consult a nutritionist to

evaluate the type of formula

being administered.

Incompatibility between the * Consult a pharmacist to evaluate

formula and medications for incompatibilities.

or incompatibility of * Give medications as described

medications given in the above.

same syringe

Formula coagulating when * Flush the tube with 30 ml of

coming contact in water before and after checking

with gastric secretions residual volumes.

Giving feeding by gravity * Consider using a pump to

(especially continuously) administer feedings if gravity

rather than using feedings result in obstruction.

Some pumps automatically flush

the tube.

Small tube lumen * Flush routinely (every 4 hours)

to avoid clogging. Small-bore

tubes tend to clog more easily.

chenoaspirit, ASN, RN · Mar 13, 2009

that didnt print out right. Here is the link, scroll down to the bottom of the page...

http://endoflifecare.tripod.com/huntdiseasefaqs/id108.html

chenoaspirit, ASN, RN · Mar 13, 2009

This may help you.

http://www.doe.virginia.gov/VDOE/Instruction/Health/SHCP4gastrointestinal.pdf

morte, LPN, LVN · Mar 13, 2009

checking for placement can only be done with xray, instilling air is only going to tell you that the tube is in the peritoneal cavity somewhere.....instilling air for placement is inre NG tubes.....! you can aspirate and check pH, but if the stomach has ruptured (about the only way the tube ISNT going to be in the stomache) you prob are going to get stomach acid anyway.

all parameters should be ordered by MD, unless you have P+P which the docs would have to have input for. there are going to be different measures for the 250# 25 yr old post trauma patient, and the 90# 90 yr old stroke victim.